Provider Demographics
NPI:1033814090
Name:MCCASLAND, THOMAS W
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:W
Last Name:MCCASLAND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987-6602
Mailing Address - Country:US
Mailing Address - Phone:507-429-9990
Mailing Address - Fax:
Practice Address - Street 1:223 CENTER ST
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MN
Practice Address - Zip Code:55987-3595
Practice Address - Country:US
Practice Address - Phone:952-746-5350
Practice Address - Fax:507-474-4890
Is Sole Proprietor?:No
Enumeration Date:2023-03-31
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNE585-094-205-718106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician